Andrew Lansley tells Nick Hughes why he will consign to the past Labour’s “inconsistent and short-term” approach to health if the Tories take power

It doesn't take Andrew Lansley long to set the combative tone for our conversation; my opening question about the effectiveness of Labour's public health strategy receives a withering response: "It's an exaggeration to describe what the government has been doing as a strategy. It's never been more than a succession of initiatives."

With less than two months to go until the general election, the shadow health secretary is stepping up his offensive against Labour's "flawed" approach to public health, which began in January with the publication of the Healthier Nation Green Paper.

In person, as in the paper, Lansley is critical of Labour's "lack of commitment" to tackling obesity, which he claims didn't get any government attention until 2004. Since then, he suggests Labour has been guilty of eschewing "long-term strategy" in favour of "short-term initiatives" such as Small Change, Big Difference; Healthy Towns; and Healthy Weight, Healthy Lives, which, he says, often get lost or superseded.

"Where at the moment are Healthy Towns?" he questions. "What has been completely lacking over the past 10 years has been any consistent process of evaluating and reporting on public health activities."

Aside from Change4Life, which would be retained and developed under a Tory government as "a brand has been established", Lansley is proposing a radical new direction on public health. He plans to create a Public Health Department, which will have its own secretariat and budget and take responsibility for diet and nutrition strategy away from the FSA.

He accuses Labour of diverting funds away from tackling obesity to plug holes in NHS finances and is firm in his commitment to increasing the net funding devoted to public health. Should the Tories win the election, Lansley will be installed as public health minister, tasked with bringing together strategy at a national level but with a clear line of accountability through to local partners who will take ownership of their own community's strategy.

He will start with a base line of spending for each local area based on health inequalities, with the poorest communities getting the biggest slice of the pie. As time goes on the increment of that budget will be distributed on the basis of a health premium, rewarding successful local strategies.

So far so different, but what's the food industry's role in Lansley's grand design? "A pretty substantial one," he says. Lansley is enthused by the idea set out by the Public Health Commission of establishing partnerships between industry and government "where if we all work together on a shared strategy with shared objectives we will try and make sure we do the least by way of legislative imposition as long as we make as good progress as we possibly can."

This means continued commitment to reformulation, moves towards meaningful front-of-pack labelling focusing on GDAs rather than traffic lights and developing a nutrient profiling system "that people feel is objectively useful and relevant".

Nudge rather than preach
The government's "inconsistent and short-term approaches" to the food industry have had a "chilling effect", making it difficult for people to invest in health, he says.

Lansley advocates the use of behavioural science to understand why consumers make bad choices and "nudge them in the right direction" rather than preaching about which foods not to eat. "We've got to help people construct good diets rather than stigmatise a small number of foods," he says.

FSA campaigns on salt and satfat are criticised for being overly crude and "not helpful at all" for consumers.

"Constructing good diets isn't about saying there are certain foods you should never eat. It's about saying, if you're constructing a diet, it's sensible to understand the implications of what happens if you eat too much of this compared with that."

So education, not legislation is the Tory health mantra. Well, not quite. If there are no bad foods under a Tory government, why did they support Ofcom proposals on banning advertising of unhealthy foods to children?

"Well we supported Ofcom's conclusion," he says, suddenly adopting a politician's tone. "Ofcom was given a job to do and it seems to us on the face of it that Ofcom reached various conclusions where that was concerned."

But surely no-one's disputing that a bowl of cereal is a reasonable way for a child to start the day? "What we're trying to do," he counters, "is to make sure parents are able to make decisions about what kind of cereals they might buy without there being an advertising impact on children that makes it difficult for adults to make their own decisions."

Lansley, in fact, wants to extend the Ofcom ban to all media on a voluntary basis, but has he seen any firm evidence that consumers are making healthier choices on the back of advertising restrictions?

"I can't tell you I have, no. But what I'm very clear about is that across public health generally, 99% of the research is an analysis of the problem and less than 1% is an analysis of the potential solutions. It's a classic illustration.

"If you've an intervention of the kind Ofcom has recommended, the logical thing is to go back in and do an evaluation of what impact it has had."

Lansley wants to use real-time sales data to evaluate the impact of health strategies and to this end plans to encourage retailers to give up their "vast amounts of very immediate information" to track the progress of recommendations.

Supermarkets will also be forced to stop below-cost selling, which the Tories are "committed to banning", with Lansley also planning to ramp up taxes on problem drinks such as alcopops and high-strength beers and ciders.

Booze and self-esteem
I put it to him that taxation is lazy policymaking and alcohol abuse is as much a cultural problem as a market issue.

On the latter point, he broadly agrees: "We need to have a behaviour change campaign in relation to alcohol because the government appears to be completely obsessed with restricting its supply, whereas we will not succeed unless we impact on people's demand for alcohol."

Where adolescent drinking is concerned, he says it's not just about education but "working with young people overall in relation to their self-confidence and self-esteem".

Lansley also questions the tobacco display ban and says the Tories will commit to reviewing the evidence surrounding the efficacy of hiding fags under the counter. "The evidence in places like Canada, for example, was very uncertain and conflicting about whether it had any impact."

As for the industry in general, Lansley says he is committed to being its friend, just as long as it keeps its side of the bargain. "My job would be to deliver improving public health. From the industry's point of view, the way we go about it is through an altogether more understanding and better long-term partnership than I hope they would feel they've experienced in the past."

Read more
Hot Topic: FSA’s venture into nutrition has brought conflict too often (13 March 2010)
Lansley vows he will rein back FSA (13 March 2010)
Tories show difference with nudge to a Healthier Nation (23 January 2010)